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There was a time when ashtrays were in every home, smoking was allowed on all airplanes, and hospitals had to deal with the surreptitious influx of off-premises cigarettes. Nearly everyone attending the May 30 Alumni Day Symposium, “Up in Smoke: 50 Years of Policy, Perception, and the Public’s Health” remembered that time well. Most of the physicians in attendance admitted they had parents who smoked. But when asked by moderator Steve Schroeder ’64, if anyone had a child who smoked, only one hand went up.

A half century after the U.S. Surgeon General published a report on the ill effects of tobacco use on health, “it is not a normal thing to smoke in this country anymore,” said Schroeder, who is the Distinguished Professor of Health and Health Care and director of the Smoking Cessation Leadership Center at the University of California, San Francisco. Currently, 18 percent of the U.S. population smokes, down from 42 percent in 1965.

The bad news, however, he added, is that smoking is increasingly a phenomenon among the poor and the poorly educated, and is especially common among people with mental illness or substance use disorders. These populations consume about 40 percent of all cigarettes sold in the nation.

Nancy Rigotti ’78, an HMS professor of medicine and director of the Tobacco Research and Treatment Center and associate chief of the Division of General Medicine at Massachusetts General Hospital, discussed physicians’ evolving response to tobacco. The thinking on smoking has moved from being considered just a bad habit to being recognized as an addiction and a chronic disease. “Patients are now told they have a problem and need treatment,” Rigotti said. “This approach has increased both short-term and long-term abstinence from smoking.” With electronic medical records and meaningful-use requirements that call for the identification of those who smoke, “we can now reach out to smokers instead of waiting for them to come to us.”

Change has also come in the marketplace. In February, CVS announced it would no longer sell tobacco products, becoming the first national retail pharmacy chain in the country to do this. Andrew Sussman ’91, senior vice president and associate chief medical officer of CVS Caremark, said the action was undertaken “to help further diminish tobacco use and make it less socially acceptable.” Approximately 1 million of CVS’s 5 million daily customers are cigarette smokers. According to Sussman, CVS has found “that doing what’s right for patients is also right for business.” One poll showed that 25 percent of respondents were more likely to shop at CVS pharmacies following the announcement that the company would stop selling tobacco products. In addition, since the announcement, the stock price of CVS rose almost 20 percent.